ESMI-III: The Effectiveness and Implementation of Maternal Mental Health Services

Background

In recent years, significant investments have been made to improve perinatal mental health care in the UK. The most recent initiative to achieve this goal was laid out in the NHS Long-Term Plan, with the implementation of Maternal Mental Health Services (MMHS). In 2021, the MMHS was implemented across 30 sites in all areas of England – referred to as ‘Early Implementer’ and ‘Fast Follower’ sites, before a national scale-up and sustainability phase in 2022-24.

The MMHS will provide multidisciplinary integrated care and support to women experiencing moderate to complex mental health difficulties arising from trauma or loss related to childbirth (e.g., post-traumatic stress following childbirth, tokophobia, miscarriage, stillbirth, neonatal death, pregnancy termination and loss of custody), whose needs are not currently met in other services.

The ESMI-III study will help identify the most optimal service delivery models and context-specific barriers to implementation across the pilot sites to inform the national roll-out.

Research Questions

We will take a Realist approach to understand which MMHS model works, for whom, in what circumstances, how and why (i.e., what are the underlying mechanisms?)
Specifically, the research aims to understand:

• the variation in MMHS service delivery models in Early Implementer and Fast Follower sites across England
• the factors (challenges and solutions) affecting the implementation of MMHS
• how effective MMHS are in improving mental health for women who have experienced trauma or loss related to childbirth
• the impact of MMHS on staff psychological, knowledge, skills, and confidence
• the feasibility and effectiveness of MMHS in providing trauma informed training across the maternity workforce
• The challenges and solutions to sustainability and scale-up of MMHS

Research Plan

The ESMI-III study is being conducted in three phases:

Phase 1: In the first phase we conducted an organisational mapping of MMHS service delivery models across England, and held focus groups with Early Implementer and Fast Follower sites. This phase helped us to understand the core components of MMHS service delivery models in different areas, and early lessons from setting up these new services. The findings informed a series of recommendations and national guidance for the implementation of MMHS.

Phase 2: In the second phase, we conducted in-depth organisational case studies with 4 Early Implementer or Fast Follower MMHS sites using a Realist approach. This phase aimed to understand the experiences of staff and women, the barriers and facilitators to implementing MMHS, and how the services are working to improve outcomes for women.  We also collected service level data to further understand the characteristics of those accessing the services, and treatment outcomes.

We have collaborated with Lancaster University and Centre for Child and Family justice to understand and support MMHS to develop their pathways of care for women at risk of separation from their baby at birth due to safeguarding concerns. Specifically, we have worked with 3 pilot sites to understand how to improve the offer through this care pathway and develop a training package to support implementation of the HOPE Boxes intervention.

Phase 3: In the third phase of this study, we will be conducting a mixed methods survey, focus groups and interviews to understand and support sustainability and scale up of MMHS. We will conduct a national survey and focus groups with MMHS at various stages of implementation. In addition, we will be facilitating trauma informed training to staff in four sites and collecting data to understand the role of MMHS in providing training. We will evaluate the effectiveness of this training in improving knowledge and confidence across the maternity workforce in supporting women experiencing mental health difficulties related to perinatal loss.

Anticipated Outputs

Findings will be shared throughout the study to help facilitate learning across the sites, and inform further development, scale-up and sustainability of MMHS nationally.

Phase 1 findings have led to the development of recommendations for addressing local and national barriers to implementation for MMHS. They have been disseminated widely through national interactive community practice workshops, and have informed national NHS England implementation guidance.

Findings from phase 1 and phase 2 will be disseminated via academic publications and conferences, workshops for clinicians, and policy briefings. In the third phase of the ESMI-III study we will disseminate findings to support the scale-up and sustainability beyond the MMHS pilot phase.